Heart Failure of the Venusian Type

Women in heart failure should be treated as a special population, which unfortunately is hampered by a knowledge gap due to under-representation of women in clinical trials on heart failure

By Nashiba M. Daud, MDUP-Philippine General Hospital

Once upon a time, legend has it that Martians and Venusians met, fell in love, and had happy relationships together because they respected and accepted their differences. Then they came to Earth and amnesia set in: they forgot they were from different planets.

Using this as springboard, former Philippine Heart Association (PHA) President Eleanor Lopez posed the question whether or not women in heart failure (HF) are a special population, during the PHA-American College of Cardiology (ACC) Joint Session of the recently concluded PHA annual convention.

Dr. Lopez underscored the unfortunate fact that through the years, women have always been under-represented in most researches. But despite this reality, women received similar treatment to that of men, she noted.

While women fear developing uterine and breast cancer, more women die of cardiovascular disease (CVD) yearly. Nearly 50 percent of the female CVD mortality is due to coronary heart disease (CHD), but one of three females die of HF as a complication. Despite this fact, HF in women remains a poorly recognized and understood syndrome and has not received the same public awareness as CHD, the former president observed.

The speaker highlighted existing guidelines in the management of HF and underscored the differences in the management of women with HF. But all existing data showed that women are underrepresented in the clinical trials.

For example, in the guideline recommendations for implantable cardioverter defibrillator (ICD) to prevent sudden death in HF, the many multicenter studies used as basis showed a predominantly male population, and few studies have provided adequate sex-specific recommendations.

Further, the limited analyses available for women do not clearly demonstrate a mortality benefit. Adherence to guidelines in the diagnosis and treatment of HF is less strict leading to under treatment in women.

Dr. Lopez concluded that women are a special population. She said that “because they are your grandmothers, your mothers, and your sisters with innate physiologic and pharmacologic differences from your male patients,” this inherent uniqueness should remind clinicians to tailor fit the management for this special population.

Dr. Lopez was president of the ASEAN Federation of Cardiology from 2010 to 2012. Dr. Alex T. Junia, immediate PHA past president chaired the session.

“In the guideline recommendations for implantable cardioverter defibrillator (ICD) to prevent sudden death in HF, the many multicenter studies used as basis showed a predominantly male population, and few studies have provided adequate sex-specific recommendations”